Thread by @abledoc

Monkeypox is an Orthopoxvirus like Small Pox or Vaccinia virus. They are brick shaped linear dsDNA viruses that replicate in cytoplasm. They bind to glycosaminoglycans to enter cells or are taken up by apoptotic mimicry #monkeypox #orthopoxvirus 1/n
viralzone.expasy.org/149?outline=al…

Small Pox is the archetypal orthopoxvirus infection of humans which infected humans from prehistory until its eradication in the 20th century through Vaccination. First true success of Vaccines 2/n #Variola #SmallPox #orthopoxvirus
thelancet.com/journals/lance…

History of Small Pox Vaccination is the history of Vaccination itself. Life long immunity produced against Small Pox, which could be mimicked by attenuated cowpox (Vaccinia) was the key to Small Pox eradication 3/n #Vaccinia #SmallPox #orthopoxvirus
ncbi.nlm.nih.gov/pmc/articles/P…

Small pox (Variola) jumped to humans from an unknown rodent in prehistory. It was originally a mild disease, became more severe over time to become the Small Pox we became familiar with. 4/n #variola #smallpox #orthopoxvirus
nature.com/articles/d4158…

Over time, small pox virus lost genes that suppressed immune response, making disease increasingly severe (since it induced lifelong immunity, evolution favored severe disease that could spread more). Viruses do not necessarily always become milder 5/n #smallpox #orthopoxvirus

Monkey Pox originates from rodent reservoirs in Africa, and humans got infected from contact with infected monkeys through bush meat trade or in labs where monkeys were used in research 6/n
It has been happening for decades but what has changed? #monkeypox
cdc.gov/poxvirus/monke…

Vaccination for Small Pox with Vaccinia offers significant but partial protection from Monkey Pox.
Eradication of Small Pox ended small pox vaccination, leaving the door open to other #orthopoxvirus like #monkeypox 7/n
cell.com/trends/microbi…

Increase in the numbers of humans with no immunity to orthopoxviruses like Small Pox after the cessation of Small Pox Vaccine has led to outbreaks in sub-saharan africa like Democratic Republic of Congo 8/n
ncbi.nlm.nih.gov/pmc/articles/P…

Outbreaks of Monkey Pox in the western hemisphere have till recently been zoonosis with human contacts getting infected from exotic animals such as prairie dogs or monkey either through pet trade or laboratory exposures. #monkeypox #orthopoxvirus 9/n
ncbi.nlm.nih.gov/pmc/articles/P…

Current outbreak of #monkeypox which started in United Kingdom has reached Montreal, Canada and Madrid in Spain. It suggests failure of contract tracing.
While Covid protocols should be effective, long incubation period (upto to 21 days) makes it difficult

https://twitter.com/Faytuks/status/1527038807509458944?s=20&t=I7WWnd5tSXMzxWfVBcLHgg

A thread on the Monkey Pox outbreak by @DrEricDing

https://twitter.com/drericding/status/1526929873419354113

10/n Monkey Pox outbreak in United Kingdom is remarkable for lack of travel history or exposure to any animal suggesting local community transmission. #monkeypox #orthopoxvirus
who.int/emergencies/di…

The first case (in a family cluster of 3) became symptomatic on 30th April and second on 5th Apr, with another unrelated cluster among gay men.
This puts the earliest date somewhere in April 11/n #monkeypox
who.int/emergencies/di…

Another unrelated case of Monkey pox in an individual who travelled to Nigeria in late April, developed rash on 29th April and returned to UK on May 3-4.
This looks like he got it in UK before going to Nigeria 12/n #monkeypox
who.int/emergencies/di…

Cases identified so far in Spain and Portugal have been in gay men (MSM), and none have symptomatic contact history nor travel history strongly pointing to community transmission 13/n Portugal/Spain is a top holiday destination for Britons
cidrap.umn.edu/news-perspecti…

Tecovirimat: Specific Treatment of Monkey Pox.
Formerly known as ST-246, Tecovirimat, is a virus Efflux inhibitor, has received fast tract FDA approval and is stockpiled by USA for #orthopoxvirus infections 13/n #monkeypox
investor.siga.com/news-releases/…

Join for a chat to discuss the current outbreak, how it is different from previous outbreaks and the prospects for a pandemic

https://twitter.com/abledoc/status/1527239621972836352

What are the Epidemiologically relevant numbers for Monkey Pox? #monkeypox
R0 ~2 vs 3.5-6 for Small Pox
Small Pox Vaccine provides ~85% protection & reduces risk of severe disease
Asymptomatic cases not known (biased by Congo strain), may not be true 14/n
ncbi.nlm.nih.gov/pmc/articles/P…

R0 of 2 means that at least 50% or more of the population must be immune to prevent a sustained outbreak. Since Small Pox vaccine provides 85% protection, we need aproximately 60% of the population to have had Small Pox vaccine in the past. Global Vaccination ended by 1982 15/n

History of the Small Pox Vaccination effort in India. I received the vaccine in my primary school in late seventies. Vaccination ended in Democratic Republic of Congo in 1982.
apps.lib.umich.edu/online-exhibit…

Monkey Pox Twitter Spaces No 1
19 May 2022

Monkey Pox: Are we at the cusp of another pandemic

twitter.com/i/spaces/1OwxW…

Clinical features of Monkeypox are similar to Small Pox (which has been eradicated) and needs to be differentiated from chicken pox and other vesicular diseases. 16/n It has more prominent febrile prodrome & longer gap between fever & rash
pubmed.ncbi.nlm.nih.gov/24158414/

Presence of glandular swelling (painful, firm and tender lymphnodes, present in two-thirds) is unique to monkey pox, versus variola (small pox) or varicella (chicken pox)
Skin lesions are all in the same phase of evolution, similar to small pox 17/n
pubmed.ncbi.nlm.nih.gov/24158414/

Diagnostic options for Monkeypox. Real-Time, quantitative PCR from the lesions would be the most widely available and practical diagnostic test
Antibodies would be useful in tracing sources as part of epidemiological investivations 18/n @RajeevJayadevan
pubmed.ncbi.nlm.nih.gov/24158414/

Clinical manifestations of Monkeypox during the outbreak of West African Strain in United States, which has lower mortality (~1%) versus more devastating Central African strain (~10% mortality) 19/n
Lower mortality does not mean patients arent miserable
academic.oup.com/cid/article/41…

Younger subjects and children in particular are more severely affected, which is compounded by lack of small pox immunity in people younger than 40-50 years.
Here is a severely affected child with retropharyngeal abscess 20/n Breathlessness may follow academic.oup.com/cid/article/41…

Note the seizures and confusion (brain involvement) as well as Joint pain and swelling.

When we ignore disease outbreaks in Africa, they fester until they come home to our own homes.
Excellent thread on a Monkeypox outbreak in Africa circa 2018. It was four years ago, inaction then has cost us dear. 21/n @Boghuma

https://twitter.com/Boghuma/status/1416569112856350735?s=20&t=8PVOfGVJhjipi5InPyYDxQ

Efficacy of Small Pox Vaccine, a cohort from Kolkata, India 22/n nature.com/articles/14250…
Mortality of 10% among unvaccinated children who contracted small pox is not at all different from the Central African strain of Monkey pox. We are lucky it is the west african strain now

Does Monkey Pox have asymptomatic transmission?
Seropositivity in otherwise "unaffected" people would prove asymptomatic infection. Here is a study in Sierra Leone showing exactly such asymptomatic seropositivity. @DrEricDing #monkeypox 22/n
bmcresnotes.biomedcentral.com/articles/10.11…

Serological testing of "upstream" contacts of the monkeypox cases can help nail down potential asymptomatic transmission and close the loop of transmission chains. Note that antibodies are not useful in current diagnosis but helpful for recent infection 23/n

WHO summary on Monkey Pox has all the relevant information updated minutes ago. #MPX #monkeypox
who.int/news-room/fact…

MonkeyPox Epidemiology. This is a pandemic 5 decades in the making, steadily gaining strength in sub-Saharan Africa, while opportunity to test Vaccines & Drugs were missed. 1/n
#monkeypox #orthopoxvirus #epidemiology
journals.plos.org/plosntds/artic…

MonkeyPox Case numbers have been rising steadily in Africa, mainly in Democratic Republic of Congo for the last 5 decades as the herd immunity to #orthopoxvirus SmallPox has been declining with cessation of Vaccination. 2/n #monkeypox #epidemiology #MPX
journals.plos.org/plosntds/artic…

Although the current outbreak outside Africa is of West African clade with relatively lower mortality 1-3%, both the strains have been rising exponentially over the decades
#monkeypox #orthopoxvirus
With such large numbers in Africa, it was about time 3/n
journals.plos.org/plosntds/artic…

What does Monkey Pox in Africa teach us?
~15% of cases in Democratic Republic of Congo have no history of contact with either animals or human cases.
Has the rate of asymptomatic transmission rise, allowing the spillover to spread this far.#monkeypox
academic.oup.com/jid/article/22…

Evolution of Variola (small pox) in humans was characterised by loss of genes over time. #Variola #SmallPox
science.org/doi/10.1126/sc…